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URL:  http://boards.fool.com/greetings-chris-id-hoped-you-would-answer-the-23169659.aspx

Subject:  Re: OT: Career crisis Date:  10/15/2005  3:12 PM
Author:  xraymd Number:  212571 of 310601

Greetings, Chris, I'd hoped you would answer. The coding aspects for codes that recur are not the ones that cause difficulty. Here's what does:

On paper, the chief complaint and a portion of the HPI are written by the medical assistant at the time she takes and documents the vitals. Then I see the patient, ask a few more focused questions, write the answers swiftly, examine the patient, write my exam findings just as swiftly, write any rx's and prepare any forms for imaging and labwork and record point by point what my diagnoses are and what I am doing to treat and investigate. The minute I think it, I can write it. I have not been obliged to hunt up the ICD-9 code for my diagnoses. It's quick and I am done once it is on paper. Next patient up next, nothing left over from the first patient.

On the EMR, I must open the patient visit, go to the specific module intended to capture chief complaint/history of medical illness, put the individual complaints into their individual boxes (the medical assistant does some of this), put the vitals into a different module into their individual boxes, go to the review of systems module and click off each little box regarding Normal or have to open yet another module to detail any abnormal review of systems, go to the physical exam module and click on each little box similarly to the review of systems module - and every time I answer that something is not Normal, yet ANOTHER box pops up asking me to further detail the degree of abnormality which I have to answer or close, then I have to go to the Assessment module to search the ICD-9 database for every single diagnosis I wish to document (when I know the codes it's easier but when I can't find them it's a showstopper because the program WILL NOT PROCEED without ICD-9 codes for everything). Having spent time to find the codes, I then have to go to the Plan module to say what I am doing for each diagnosis, then I have to go to the Rx module to put in every single prescription (each time having to re-enter my password because it is not set up to allow me to input it once per session or even per patient) that I wish to print out - sometimes I can't even find the desired med when I search for it - then I have to go to the printer to collect all my scripts to sign. Then I have to go to the lab module to enter lab requests that I used to simply circle. Then I have to go to the imaging module to detail requests I have for imaging - xrays, CTs, mammograms, bone density scans. Then I have to encode the results of any EKGs I've done (can't just write it anymore on the EKG itself - have to ALSO do this). And this is just for urgent care visits. For Establish Care visits, I have not even mentioned what needs to be done to capture past medical history, social history or family history on this system - each with their own modules with multipart steps for each, and none of the modules passe